Background Postnatal depression and caregiving difficulties adversely affect mothers, infants, and later childhood development. In many countries, resources to help mothers and infants are limited. Online group–based nurse-led interventions have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period. Objective This study tested the effectiveness of a 4-month online group–based nurse-led intervention delivered when infants were aged 2 to 6 months as compared with standard care outcomes. Methods The study was a block randomized control trial. Mothers were recruited at the time they were contacted for the postnatal health check offered to all mothers in South Australia. Those who agreed to participate were randomly assigned to the intervention or standard care. The overall response rate was 63.3% (133/210). Primary outcomes were the level of maternal depressive symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS) and quality of maternal caregiving assessed using the Parenting Stress Index (PSI; competence and attachment subscales), the Parenting Sense of Competence Scale (PSCS), and the Nursing Child Assessment Satellite Training Scale. Assessments were completed at baseline ( mean child age 4.9 weeks [ SD 1.4]) and again when infants were aged 8 and 12 months. Results Outcomes were evaluated using linear generalized estimating equations adjusting for postrandomization group differences in demographic characteristics and the outcome score at baseline. There were no significant differences in the intervention and standard care groups in scores on the PSI competence subscale ( P =.69) nor in the PSCS ( P =.11). Although the group by time interaction suggested there were differences over time between the EPDS and PSI attachment subscale scores in the intervention and standard care groups ( P =.001 and P =.04, respectively), these arose largely because the intervention group had stable scores over time whereas the standard care group showed some improvements between baseline and 12 months. Mothers engaged well with the intervention with at least 60% (43/72) of mothers logging-in once per week during the first 11 weeks of the intervention. The majority of mothers also rated the intervention as helpful and user-friendly. Conclusions Mothers reported that the intervention was helpful, and the app was described as easy to use. As such, it appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services. Possible explanations for the lack of differences in outcomes for the 2 groups in this study are the failure of many...

The objective of this study was to determine the prevalence, circumstances, and outcome of fractures in males with Duchenne muscular dystrophy (DMD) attending neuromuscular clinics. Three hundred and seventy-eight males (median age 12 years, range 1 to 25 years) attending four neuromuscular centres were studied by case-note review supplemented by GP letter or by interview at the time of clinic attendance. Seventy-nine (20.9%) of these patients had experienced fractures. Forty-one percent of fractures were in patients aged 8 to 11 years and 48% in independently ambulant patients. Falling was the most common mechanism of fracture. Upper-limb fractures were most common in males using knee-ankle-foot orthoses (65%) while lower-limb fractures predominated in independently mobile and wheelchair dependent males (54% and 68% respectively). Twenty percent of ambulant males and 27% of those using orthoses lost mobility permanently as a result of the fracture. In a substantial proportion of males, the occurrence of a fracture had a significant impact on subsequent mobility.

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Background: Severe Neurological Impairment (SNI) is a term for which there is no consistently used definition. This may hamper consistency in the reporting of research in the area and communication between professionals involved in the care of those with SNI. Objective: We aimed to create an international, multidisciplinary, consensus-based definition of SNI. Design: The Delphi method was employed to reach consensus on the definition of SNI. Method: An international, multidisciplinary expert panel was recruited. The process proceeded over three rounds with feedback provided to panellists between each of them. Consensus was defined as 70% agreement. A working definition was created and, following presentation at an international meeting and consultation with parent representatives, further refined, to create a finalised definition. Results: Thirty-four expert panellists commenced the process. Six items reached the threshold of consensus. The finalised definition is as follows: "Severe Neurological Impairment describes a group of disorders of the central nervous system which arise in childhood, resulting in motor impairment, cognitive impairment and medical complexity, where much assistance is required with activities of daily living. The impairment is permanent but can be progressive or static." Conclusion: A consensus-based definition of SNI which includes multidisciplinary , international and parental input has been created. This should prove useful for clinical, research and resource-planning purposes.

The objective of this study was to determine the prevalence, circumstances, and outcome of fractures in males with Duchenne muscular dystrophy (DMD) attending neuromuscular clinics. Three hundred and seventy-eight males (median age 12 years, range 1 to 25 years) attending four neuromuscular centres were studied by case-note review supplemented by GP letter or by interview at the time of clinic attendance. Seventy-nine (20.9%) of these patients had experienced fractures. Forty-one percent of fractures were in patients aged 8 to 11 years and 48% in independently ambulant patients. Falling was the most common mechanism of fracture. Upper-limb fractures were most common in males using knee-ankle-foot orthoses (65%) while lower-limb fractures predominated in independently mobile and wheelchair dependent males (54% and 68% respectively). Twenty percent of ambulant males and 27% of those using orthoses lost mobility permanently as a result of the fracture. In a substantial proportion of males, the occurrence of a fracture had a significant impact on subsequent mobility.Skeletal changes in Duchenne muscular dystrophy (DMD; including osteoporosis and decreased build-up of cortices in long and flat bones) result in increased fracture prevalence (Hsu 1982). This expected increase in the frequency of bony injury has been supported by a number of small studies (Hatano et al. 1986, Granata et al. 1991, Larson 2000. However, data available are limited: patient numbers are small and studies usually arise from orthopaedic units, introducing the possibility of selection bias. It is important to establish the fracture prevalence in this condition, particularly in view of the increasing interest in the possible therapeutic role of steroids with their potential side effects. Our study aimed to establish the prevalence of fractures among a cohort of males with DMD attending neuromuscular clinics. MethodWe studied patients with DMD attending neuromuscular clinics at four centres in the UK (Hammersmith, Birmingham, Bristol, and Oxford). Males born on or after 1 January 1975 were included. Diagnostic criteria (consistent muscle histology and histochemistry with or without an identified deletion at Xp21) were established before inclusion in the study.This was a retrospective study and patients were assessed in one of two ways. For the first group, the fracture history was established using hospital case-note review and GP questionnaires. Hospital notes were reviewed using a set protocol which detailed patient date of birth, age, and mobility status at the time of fracture, mechanism of fracture, site of fracture and outcome, and exposure to steroids before or at the time of fracture. Each patient's GP was contacted by letter and asked to complete a questionnaire incorporating the same protocol. Supplementation of hospital note information by GP contact was thought necessary as fractures occurring in the interval between hospital visits may not have been discussed or recorded at the neuromuscular clinics. There was no direct patient conta...

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Aim To examine pro‐ and anti‐inflammatory cytokines in children with cerebral palsy (CP) at baseline and in response to endotoxin (lipopolysaccharide), and correlate outcomes compared with age‐matched comparisons, to evaluate their ability to mount an immune response. Method Serum cytokines were assessed in 12 children (eight males, four females; mean age 10y 1mo [SD 1y 8mo], 6–16y) with CP against 12 age‐matched comparisons (eight males, four females; mean age 9y 1mo [SD 1y 1mo]). Pro‐ and anti‐inflammatory cytokines (interleukin‐1β, interleukin‐2, interleukin‐6, interleukin‐8, interleukin‐10, interleukin‐18, tumour necrosis factor [TNF]‐α, TNF‐β, interferon‐γ, granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], vascular endothelial growth factor [VEGF], erythropoietin, and interleukin‐1 receptor antagonist) were measured at baseline and in response to in vitro simulation with lipopolysaccharide by multiplex enzyme‐linked immunosorbent assay. Results Significantly higher erythropoietin was found at baseline in children with CP compared with the comparison group. There was a strong response to lipopolysaccharide for interleukin‐8, VEGF, TNF‐α, and GM‐CSF in both children with CP and the comparison group; however, there was significant lipopolysaccharide hyporesponsiveness in children with CP compared with the comparison group for interleukin‐1α, interleukin‐1β, interleukin‐2, and interleukin‐6. Interpretation Altered cytokine responses in children with CP compared with the comparison group demonstrate an altered inflammatory state that may contribute to ongoing sequelae and could be a target for therapy. What this paper adds Altered inflammatory responses persist in children with cerebral palsy (CP). Erythropoietin is elevated in children with CP compared with the comparison group. Children with CP have reduced interleukin‐1α, interleukin‐1β, interleukin‐2, and interleukin‐6 inflammatory responses to lipopolysaccharide.

Background: Cytokines are possible mediators of neuroinflammation and associated with adverse outcome in neonatal encephalopathy (NE). Our aim was to explore cytokine response in children with Neonatal Encephalopathy (NE) at school age compared to age-matched controls. Method: Follow up at school age, children who had NE and age-matched controls were assessed for their cytokine responses and neurodevelopment outcome. Pro-and anti-inflammatory cytokines in the serum, [Interleukin (IL)-1α, IL-1β, IL-2, IL-6, IL-8, IL-18, Tumor necrosis factor (TNF)-α, TNF β, Interferon (IFN)-γ, granulocyte-macrophage colony-stimulating factor (GM-CSF), vascular endothelial growth factor (VEGF), erythropoietin (EPO), IL-10 & IL-1RA] were measured at baseline and in response to in vitro stimulation with lipopolysaccharide (LPS: endotoxin). Results: GM-CSF, TNF-β, IL-2 IL-6 and IL-8 were significantly elevated at school age following NE (n = 40) compared to controls (n = 37). A rise in GM-CSF, IL-8, TNF-α, IL-1β, & IL-6 were seen in NE group following LPS stimulation. Relative LPS hypo-responsiveness was also noted in children with severe NE with IL-10, VEGF, EPO and TNF-β. Elevated TNF-β was associated with low gross motor scores on assessment at school age. Conclusion: School-age children post-NE had significantly altered cytokine responses to endotoxin compared to controls. TNF-β was associated with adverse developmental outcomes. This suggests the inflammatory process may persist into childhood and a longer therapeutic window may be available for neuroprotection therapies.